Comparison of Results and Cost-Effectiveness of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion: A Meta-Analysis of Prospective Cohort Studies

Abstract

Backgraund: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is becoming the most popular treatment method in modern vertebrology. But at the same time, limited working space, significant intraoperative radiation exposure and high risks of developing perioperative complications associated with a long learning curve are constraints for the widespread use of this technology by most spinal surgeons. Aims: to conduct a meta-analysis based on the results of prospective cohort clinical studies that compare the results of the application of minimally invasive and open transforaminal interbody spinal fusion techniques in treating patients with degenerative lumbar diseases. Materials and methods: A search for randomized clinical trials was conducted in the Pubmed, EMBASE, eLibrary and Cochrane Library databases published from January 2008 to December 2018, which compared the results of minimally invasive (MIS-TLIF) and open (Open-TLIF) techniques transforaminal interbody fusion in treating patients with degenerative diseases of the lumbar spine. For dichotomous variables, the relative risk and 95% confidence interval were calculated; in turn, standardized difference of mean values and their 95% confidence intervals were used for continuous variables, using the random effects model. Results: The meta-analysis included 21 prospective cohort studies, three of which were randomized controlled clinical trials. The results of the surgical treatment of 1762 patients with degenerative diseases of the lumbar spine were evaluated in total. In the MIS-TLIF group, reliably smaller parameters of the duration of surgical intervention (p0.00001), the volume of intraoperative blood loss (p0.00001), the timing of postoperative inpatient treatment (p0.00001), the economic costs of treatment (p0.00001) and the number of perioperative adverse effects (p=0.006). At the same time, the duration of intraoperative fluoroscopy is registered significantly less in the Open-TLIF group (p0.00001). Conclusions: The MIS-TLIF method in comparison with the Open-TLIF method has significantly lower objective indicators characterizing the invasiveness of the surgical intervention, as well as the development of undesirable consequences, the associated shorter duration of hospitalization and financial costs for treating patients with degenerative diseases of the lumbar spine. At the same time, significantly more time of intraoperative irradiation was confirmed, due to the technical features of performing transcutaneous closed manipulations in the absence of direct visualization of the operated segment in the MIS-TLIF group.

Accelerated Recovery Program for Patients with Polysegmental Degenerative Lumbar Spine Disease

“…For patients with symptomatic degenerative diseases of the lumbar spine, the method of transforaminal interbody fusion with transpedicular stabilization is considered most appropriate [ 2 ]. On the one hand, minimally invasive dorsal interventions can reduce tissue damage and local pain during surgery; on the other hand, the long-term clinical and radiological outcomes of these techniques are not less successful than those of open decompression-stabilizing interventions [ 3 , 4 ]. Considering the multilevel nature of vertebral pathology and the risks of polysegmental manipulations, it is crucial to further improve the treatment for degenerative diseases of the lumbar segments [ 5 ].…”